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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

Utah rates for HCPCS A4383

Ostomy pouch, urinary, for use on faceplate, rubber, each

Rates data updated July 2026.

Facilitymedian $11 · 10th–90th $11$260%50%90th$11Professionalmedian $28 · 10th–90th $11$1700%10%10th90th$28$0.5$2.0$10.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$10.72
Typical High
$10.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$25.70
Typical High
$169.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$26.92
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$26.30
Molina
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$28.84
Typical High
$37.15
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$21.88
Median
$28.18
Typical High
$44.67
Select Health
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Select Health
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$39.81
Typical High
$39.81
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$39.81
Typical High
$47.86
United
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$15.14
Typical High
$16.60
United
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$16.60
Typical High
$25.12